Written by

Walter F. Roche Jr. and Tom Wilemon

The Tennessean

Where to call for help

For information about meningitis in general: 1-800-222-1222. For mental health counseling for anxiety related to the outbreak: 1-855-CRISIS-1.

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State and federal officials are issuing a new alarm in the ongoing outbreak of disease caused by tainted steroids from a Massachusetts drug compounder — and the warning applies even to those who may have thought they had dodged serious illness.

While the cases of deadly fungal meningitis are on the decline, there has been a recent surge in potentially dangerous injection site infections, both in patients who already have been diagnosed with meningitis and in those who have not, health officials said Tuesday.

“We are seeing both new patients presenting and then patients who have had meningitis,” said Dr. Marion Kainer, director of healthcare-associated infections with the Tennessee Health Department.

On Monday, the department will begin a new round of contact calls to 1,009 patients who received injections in Tennessee from three tainted lots of methylprednisolone acetate from the New England Compounding Center.

Patients who were already contacted once will be contacted again and warned to be on the lookout for signs of an infection, said Dr. William Schaffner of Vanderbilt University, who participated in a briefing on the new alert Tuesday.

“Tennessee is going to be very proactive,” he said.

Steroids from the Massachusetts compounding pharmacy have been linked to 490 illnesses and 34 deaths nationwide. In Tennessee, 82 people have been sickened and 13 have died.

Schaffner said data from the U.S. Centers for Disease Control and Prevention indicate that Tennessee is beginning to experience the same upsurge of infections that had previously been noted in Michigan. Michigan and Tennessee have consistently been the hardest hit in the ongoing outbreak.

Patients experiencing any increased pain at the injection site or other symptoms such as a change in bowel or bladder control should immediately contact their physicians, he said.

According to the new CDC advisory, of the 91 cases reported since Nov. 4, two-thirds had a spinal or epidural abscess or a bone infection of the vertebrae, while only 29 percent were classified as meningitis. Two cases were infections of joints other than the spine, and two patients had more than one condition.

“Previously we saw a lot of meningitis,” Kainer said.

The CDC also warned that while some patients will experience new or worsening back pain, symptoms of an infection “may be mild or clinically difficult to distinguish from the patient’s baseline chronic pain.”

It recommends that physicians order MRIs with contrast of the affected area in patients with new and worsening symptoms. But the CDC said that in patients being treated for meningitis, even in the absence of new or worsening symptoms at or near the injection site, “clinicians should strongly consider obtaining an MRI” within two or three weeks after diagnosis of meningitis.

Kainer stressed that these infections do not cause rapid death as meningitis can. Meningitis occurs when the brain and spinal membranes become inflamed from an infection. The fungal meningitis outbreak has caused strokes in patients.

She stressed that patients should not panic about this new wave of infections that are not meningitis. The health department will be providing descriptions of symptoms and guidance about where to go for treatment.

“We don’t want people rushing to emergency departments,” Kainer said.

“This, if it is untreated or unrecognized for some time, potentially could end up as causing meningitis, but it doesn’t happen just like overnight is what we believe,” Kainer said.

The Tennessee Department of Health has compiled data on the secondary infections but is still verifying its numbers.

“We still need to get a better understanding of all of this,” Kainer said. “This is, as people have said, uncharted medical territory.

“We’re working together with CDC and the other states to really try to work out who is getting this, what are the risk factors, what is the best way to try to prevent this from happening and what’s the best way of treating this. We’re in the information-gathering stage.”

Patients need to be alert, because some of the symptoms might not initially appear to be connected to the epidural steroid injections, she said.

“If they have had severe constipation or urinary retention or urinary or fecal incontinence, those symptoms and signs people may not necessarily think may be related to this — and we want to make sure people are aware of those,” she said.